Fira Rafał, Orecka Bogusława, Namysłowski Grzegorz, Misiołek Maciej, Scierski Wojciech
Katedra i Oddział Kliniczny Laryngologii Sl.AM w Zabrzu.
Otolaryngol Pol. 2006;60(4):529-35.
Chronic hypertrophic laryngitis concerns many people in our population. Their etiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. Organic voice disorders of the larynx, particularly concerning vocal folds are the cause of dysphonia. Both surgical and conservative methods in the treatment of patients with laryngeal hypertrophy are applied. Objective assessment of the voice improvement after microsurgery is the subject of discussion of many authors. The problem of voice improvement is rarely approached to in the comprehensive way, that is with reference to activity and anatomy of the larynx. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of subjective and videostroboscopic voice analysis. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness.
The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Voice quality examinations were done just before microsurgery and 3 months after the operation. On the basis of histopathological results, following diagnosis were established: vocal fold polyps (oedematosus, teleangiectaticus and inflammatorius), oedema Reincke, laryngeal papilloma, laryngeal granuloma and cyst. The research methodology included: perceptual voice examination based on GRBAS scale (G--grade; R--roughness; B--breathiness; A--asthenicity; S--strain) and assessment of vibrations of vocal folds in videostroboscopy. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes.
In both groups (with minor and extensive vocal fold lesions) significant improvement in perceptual and videostroboscopic voice parameters was observed. The results in the group with minor vocal fold lesions were better after microsurgery.
The methodology based on the application of the two methods of voice examination could be an objective rate in the estimation of the treatment progress.
慢性肥厚性喉炎困扰着很多人。其发病机制复杂，通常与职业或环境暴露等外源性有害因素有关。喉部的器质性嗓音障碍，尤其是涉及声带的障碍，是发声困难的原因。治疗喉肥大患者的手术和保守方法都有应用。对显微手术后嗓音改善情况进行客观评估是许多作者讨论的主题。嗓音改善问题很少从全面的角度进行探讨，即参照喉部的活动和解剖结构。本研究的基本目的是基于主观和视频频闪喉镜嗓音分析评估显微手术后喉部的发声功能。第二个目的是根据声带肥大的程度评估手术治疗效果。
本研究选取了2003年1月至12月在扎布热西里西亚医科大学喉科学系接受治疗的50例声带肥大患者。所有接受检查的患者均接受了经典显微手术。在显微手术前及术后3个月进行嗓音质量检查。根据组织病理学结果，确立了以下诊断：声带息肉（水肿型、毛细血管扩张型和炎症型）、Reinke水肿、喉乳头状瘤、喉肉芽肿和囊肿。研究方法包括：基于GRBAS量表的感知嗓音检查（G——等级；R——粗糙度；B——气息声；A——无力；S——紧张）以及视频频闪喉镜检查中声带振动的评估。比较了两组声带肥大程度不同的患者的检查结果。对照组有30名无任何嗓音障碍且非职业用嗓的受试者。
两组（声带轻度和重度病变组）在感知和视频频闪喉镜嗓音参数方面均有显著改善。声带轻度病变组显微手术后的结果更好。
基于两种嗓音检查方法应用的方法学可以作为评估治疗进展的客观指标。
